Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Requirements Related to Surprise Billing; Part II; Patient-Provider Dispute Resolution Process New 26659 322189 32112898 Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction cms-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction cms-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction cms-10853
Form and Instruction CMS-10853
Form and Instruction cms-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-10853
Form and Instruction CMS-108i53
Total burden requested under this ICR: 26659 322189 32112898  
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